Examples of patient symptoms and complaints attributable to dry eye syndrome include: "dryness, redness, burning, reflex tearing, itching, foreign body sensation, grittiness, stinging, soreness, photophobia, and pain”.
Lacrimal punctal plug is considered medically reasonable and necessary for patients with the following:
• Symptomatic severe dry eyes that are not adequately treated by conservative interventions including a 2 or more week trial of artificial tears, ophthalmic cyclosporine where indicated, and adjustment to medications that may contribute to dry eye syndrome; and
• A diagnosis of severe dry eye (also known as dry eye syndrome, keratoconjunctivitis sicca, xerophthalmia, xerosis, or sicca syndrome) confirmed by:
One or more of the following diagnostic tests:
• Tear Break-Up Time (TBUT), Schirmer test,
• Ocular surface dye staining pattern (rose bengal, sodium fluorescein, or lissamine green); AND
Slit lamp biomicroscopic exam documented within the medical records.